224917 10/08/2013 »,f CITY OF CARMEL, INDIANA VENDOR: 357526 Page 1 of 1
ONE CIVIC SQUARE HENRY SCHEIN INC
CARMEL INDIANA 46032 DEPT CH 10241 CHECK AMOUNT: $2,253.53
,
PALATINE IL 60055-0241
CHECK NUMBER: 224917
CHECK DATE: 10/8/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
102 4239011 5526927-01 458 . 03 SPECIAL DEPT SUPPLIES
102 4467006 5526927-01 1, 795 . 50 EMS EQUIP
02HENRY SCHEIN'
SHIP TO/SOLD TO:
EMS Carmel Fire Department MI
135 Duryea Road, Melville, NY 11747 ®� 540 W 136th St
Station 46 Michael Kaufmann
Carmel,IN 46032-8806
010000130857105526927110010000002253530913136 BILL TO:
Carmel Fire Dept MI
2 Civic Sq
Carmel, IN 46032-7543
Carmel Fire Dept BILL To I SHIP To I INVOICE AMOUNT
2 Civic Sq
Carmel, IN 46032-7543 1308571 1817102 2253 .53
INVOICE# I INVOICE DATE
5526927-01 9/13/13
CUSTOMER PO#
MARK
HSI ORDER# ORDER DATE DUE DATE
12646253 09/13/13 10/13/13
D&B#:01-243-0880
WHSE DEA# RH0162494 Fed ID: 11-3136595
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........
his order has been processed by our MIDWEST D.C.
5315 WES 74TH STREET
INDIANAP LIS,IN 46268
RK 317-57 -2663
17-428-878
---------- --------------------------------- ------ ----- ------------- -------
1 987-8154 PU 100/BX SYR DISP 3CC W/22X11/2 LUERLCK 2 2 * 12.10 24.20 6
2 101-5979 6/BX CLOTH SURGICAL TAPE 2"X10YD 12 12 C 7.77 93.24 7
HIS PRODUCP IS BEING SHIPPED FROM OUR NORTHEAST DIS RIBUT ON CENTER.
ASE GOOD I EM, MAY BE SHIPPED SEPARATELY.
3 166-0251 100/BX BANDAGE CAREBAND ADH STRP 1X3" 12 12 C 1.07 12.84 1
LEASE NOTE 1126133 IS NOW 1660251
ASE GOOD I EM, MAY BE SHIPPED SEPARATELY.
4 935-6155 50/PK BLUE SENSOR SP ELECTRODES 150 150 11.97 1795.50 6
5 890-6800 EA SHARPS SHUTTLE SINGLE USE P2 25 25 1.61 40.25 6
6 602-8100 EA COLLAR STIFNECK SELECT ADULT 50 50 C 5.75 287.50 5
ASE GOOD I EM, MAY BE SHIPPED SEPARATELY.
HE PRICES 3TATED ABOVE MAY REFLECT A DISCOUN OR BE SUBJECT TO A REBATE YOU
UST FULLY D ACCURATELY REPORT THIS STATED DISCOUNr PRICE, OR IF APPLI ABLE,
Y NET PRI ING, AFTER GIVING EFFECT TO ANY REBATES, TO ME ICARE, MEDICAID,
RICARE AND ANY OTHER FEDERAL OR STATE PROGRAM UPON EQUESI BY ANY SUCH PROGRAM.
IT ISYOUR ESPONSIBILITY TO REVIEW ANY AGREEMENTS OZ OTHE DOCUMENTS AP LICABLE
BILL TO SHIP TO INVOICE INVOICE AMOUNT ITEM STATUS KEY REM KEY
13-nackordered:Item will follow SK-School Kit
1308571 1817102 5526927-01 2 2 5 3 .5 3 D-Discontinued:Item no longer available Nc-No charge
h-Special Schein Free Goods
HSI ORDER# ORDER DATE INVOICE DATE # OF BOXES M-Manufacturer will ship Item directly to you
1'-Prescription Drug;Return Authorization Required
12646253 09113113 9/13/13 7 R-RefngeratedItem:Maybeshippedseparately
$ -Special Schein Pricing
CUSTOMER PO# PAGE# T-Taxable Item
Temporarily unavailable;please reorder
MARK 1 OF 2 • -Item has MSDS Continued on Next Page..........
12646253 09/13/13 10/13/139
o&o#:u/'z4s-0ann
TO THESE PZICES TO DETERMINE IF THEY ARE SUB,TECT TO A REBPTE. THE FEDERAL
3OVERNMENTI14POSES CERTAIN RESTRICTIONS ON, AND REQ=ES PUELIC REPORTING OF,
DISCOUNT PR)GRAM (E.G. POINTS, DISCOUNT REDEM)TIONS )R OTHER SPECIAL AWAI"DS) ,
ITH YOUR P JRCHASES YOU MAY EARN POINTS/CREDI 'S REDE EMABLE FOR CERTAIN GOODS OR
SERVICES, Ii ACCORDANCE WITH DISCOUNT PROGRAM RULES. UPON DISCOUNT RECEIPT BY
REDEMPTION )F YOUR EARNED POINTS/CREDITS, YOU ARE RE-EIVINC OR WILL RECEIVE
NTOTICE OF TiE DISCOUNT VALUE. ACCORDINGLY, YOJ SHOUL) RETAIN THESE RECOR)S.
11 WEAVER R)AD
DENVER, PA 17517
MERCHANDI E TOTAL 2253.53
Invoice Date + 30 days 2253.53
Please remi payments only to the following aldress:
Henry Scheii, Inc.
Dept CH 102 1
Palatine, 1, 60055-0241
BILL TO SHIP TO INVOICE# INVOICE AMOUNT ITEM STATUS KEY REM KEY,
1308571 1817102 5526927-01 22S3 .53 :)- )iscontinued tem no longer available NC-No Charg
F-Special Schein Free Goods
HSI QRDER# ORDER DATE INVOICE DATE # OF BOXES M-Manufacturer�vili ship item directly to you
1) Prescription Drug:Return Authorization Required
12646253 09/13/13 9/13/13 7 R Refrigerated Item:May beshipped separately
$ Special Schein Pricing
Temporarily unavailable;please reorder
MARK F- 2 OF 2 Item has MSDS
<'eqy Ir,rat: g:; ;'„ 5:
Y^a make>very 0 0?o maintaill prices`;,r the dijrat o of a ,payment by CHECK or by the HENRY SCHEIN CREDIT CARD,
catalog, ':oi,EBVer,,y,,e resert'e t'e E'ivht p make pride adj ustments VISA,MASTERCARD,DISCOVER and AMERICAN EXPRESS
response to manufacturers'price changes
Guaranteed Satisfaction: v'sa _ %
if.1ou have tried a moduot and it is defective or does not oertorm snit
satisfactorily,we ill provide a credit, refund,or exchange-,its your Avai able to iicuns>ud ;rat>#i#ion ers`in the U.S.Ai!invoices are
choice, Simply call our customer service�depart,-,er t YY thin 30 days t
of receipt of they merchandise,to arrange for the return. For a
payable,within.3 i clays,
Y^arranf,,t r;Dair or it yo {tire slat something yo:i did not cider,
S:-ply call, i x Products & Controlled Substances:
trx Medical 1-800-845-3550
Regulations require r<s to limit fhe sale of Rx and controlled
substances only to registered,lice)sed healthcare professionals.
If you are a new customer or have rere tly moved,;'lease fur?'sti
us:ritl a copyl pf Your updated state registration. For controlled
substances,f:<rnish a copy of your DEA certificate,verifying
shippir€g address, lass!( irut s ca be ord�.red ur€1,by -:ail.
International Orders:
,Please Note:
............._................... ......
We r €adly n,'e healthcare ,rofe ssionals an governments
Opened handpieceS and equipment may not be returned far ti,:, ��`; '� �
throughout the..orld, Sul place orders or for _"q r es on export
credit,b€t 4°v ll be rE;pa r d or replaced in accordance.J fh terms and conditions,please contact cur l n erna orial Department:
manufa,cti rar:4.«rrantie s,Before opening ha dpleces or :-800-845-3550
equipment,S.i Si QgeSt that"'OU check the shipping cointainer
and packing list to varify that You have received exactly what
you ordeied,Operied C�arnputer Sof fare is not returnable, Prescription Drug Returns Instructions:
Other restrictions may also apply,
A Return Authorization is Required for al!Prescription t:n.igs.Si?-:ply call
our Customer arv�ce,Depa Event :1 800'84 ASS;I,
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LP300
Prescribed by State Board of Accounts City Form No.201(Rev.1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice or bill to be properly itemized must show: kind of service,where performed, dates service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
5526927-01 $1,795.50
5526927-01 $458.03
1 hereby certify that the attached invoice(s), or bill(s), is(are)true and correct and I have audited same in accordance
with IC 5-11-10-1.6
20
Clerk-Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
Henry Schein
IN SUM OF $
Dept Ch 10241
Palatine, IL 60055
$2,253.53
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
r
1120 5526927-01 102-670.06 $1,795.50 1 hereby certify that the attached invoice(s), or
1120 5526927-01 102-390.11 $458.03 bill(s) is (are) true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
OCT - 7 2013
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund